RNY Bypass Fails to Help Veterans

The Roux-en-Y (RNY) procedure is “inherently more difficult” because of anatomical differences from women. The procedure also has a higher perioperative mortality rate in large men.

Analysis showed:
Eleven of 850 surgical case patients (or 1.3%) died within 30 days of surgery.

Any RNY benefit vanished in a statistically rigorous analysis that controlled for a host of co-varying factors, Maciejewski and colleagues reported online in the Journal of the American Medical Association and at the Academy Health Annual Research Meeting in Seattle

But the benefit vanished in a statistically rigorous analysis that controlled for a host of co-varying factors, Maciejewski and colleagues reported online in the Journal of the American Medical Association and at the AcademyHealth Annual Research Meeting in Seattle

By Michael Smith, North American Correspondent, MedPage TodayPublished: June 12, 2011Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco andDorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

In a retrospective cohort study of predominantly male U.S. veterans, crude mortality rates were lower over six years for those who had the surgery than for controls, according to Matthew Maciejewski, PhD, of the Durham VA Medical Center in Durham, N.C., and colleagues.

But the benefit vanished in a statistically rigorous analysis that controlled for a host of co-varying factors, Maciejewski and colleagues reported online in the Journal of the American Medical Association and at the AcademyHealth Annual Research Meeting in Seattle

In large men, they noted, the Roux-en-Y procedure is “inherently more difficult” because of anatomical differences from women. The procedure also has a higher perioperative mortality rate in large men.

On the other hand, no studies have focused on high-risk patients, they noted. To help fill the gap, they turned to a cohort of 850 older, high-risk patients who had bariatric surgery between January 2000 and December 2006 at 12 Veterans Affairs medical centers.

They were matched with 41,244 nonsurgical controls from the same centers, with follow-up through December 2008 for an average of 6.7 years, the researchers reported.

Analysis showed:

Eleven of 850 surgical case patients (or 1.29%) died within 30 days of surgery.

To get a clearer picture, they conducted a propensity-matched analysis of 847 cases and 847 controls, which created cohorts that were similar in all observed characteristics except year of study entry.

In that analysis, Maciejewski and colleagues reported, the mortality differences all but vanished.

The study was supported by the Department of Veterans Affairs.

Maciejewski reported financial links with Takeda Pharmaceuticals, Novartis, the Surgical Review Corporation, the Research Data and Assistance Center at the University of Minnesota, and Amgen.